MEDICARE: EDITH MILLER SLP-CCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	106193	TX

General Provider Information

NPI Number	:	1174988786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH MILLER SLP-CCC

Provider Business Mailing Address
First Line	:	2 RIVERWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1939
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 RIVERWAY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-1939
Country	:	US
Telephone Number	:	713-965-9998
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/24/2015
Last Update Date	:	12/24/2015

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Directions to “ EDITH MILLER SLP-CCC” Practice Location

Language	Start Address	Practice Location

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